How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology

Summary

This video explains rheumatoid arthritis (RA), highlighting that the condition varies from person to person and is more common in women, typically affecting those in their forties and fifties. A rheumatologist diagnoses RA through medical history, physical exams, and blood tests like rheumatoid factor and anti-CCP antibodies. Imaging tests such as x-rays and ultrasounds help assess joint damage. Regular monitoring helps track disease progression. Early treatment is essential to prevent joint damage, and understanding individual symptoms is key to effective management.

Takeaways

• 👩‍⚕️ Rheumatoid arthritis (RA) does not present the same way in all individuals and is more common in women, usually appearing in people in their 40s and 50s.
• 🔬 A rheumatologist typically diagnoses RA through a combination of medical history, physical examination, blood tests, and sometimes imaging like X-rays.
• 🦴 During the physical exam, a rheumatologist examines joints for swelling and pain, counting the number of affected joints. This exam is repeated to assess treatment effectiveness.
• 🩸 Blood tests like rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, ESR, and C-reactive protein (CRP) help diagnose RA and monitor inflammation.
• ❌ Not all RA patients will have positive RF or anti-CCP results. Those with negative results but RA symptoms are classified as having seronegative RA.
• ⏳ The duration of joint pain and swelling, typically around six weeks, is crucial for diagnosing RA.
• 🩺 A detailed medical history is essential to identify other conditions that may impact RA treatment or diagnosis.
• 📊 Imaging tests like X-rays, ultrasound, or MRI can reveal joint damage and monitor disease progression, helping adjust treatment plans.
• ⚠️ RA is a progressive disease that can worsen over time without treatment, with significant damage occurring within the first two years.
• 🏥 Early diagnosis and treatment are critical to slowing disease progression and preventing irreversible joint damage.

Q & A

What is rheumatoid arthritis (RA) and who is most commonly affected?

Rheumatoid arthritis is an autoimmune disease that causes pain and swelling in the joints. It is more common in women and typically begins in people in their forties and fifties, although it can start at any age.

How is rheumatoid arthritis diagnosed?

RA is usually diagnosed by a rheumatologist through a combination of a detailed medical history, physical exam, blood tests, and possibly imaging like x-rays or ultrasound. The diagnosis often involves ruling out other causes of symptoms.

What is the purpose of the physical exam in diagnosing RA?

During the physical exam, a rheumatologist checks the joints for swelling and pain. They perform a joint count to see how many joints are involved. This exam helps assess the severity of RA and monitor treatment effectiveness in future appointments.

How long do symptoms need to persist before RA is considered a likely diagnosis?

Symptoms of joint pain and swelling typically need to persist for about six weeks before RA is considered a possible diagnosis.

What blood tests are used to help diagnose RA?

Several blood tests are used, including the rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). These tests help assess inflammation and the presence of specific markers for RA.

What is the difference between rheumatoid factor and anti-CCP in diagnosing RA?

The rheumatoid factor is found in about 75% of RA cases, but can also be present in other conditions. Anti-CCP is more specific to RA and indicates a higher likelihood of a more aggressive form of the disease.

What is seronegative RA?

Seronegative RA refers to cases where a person has RA symptoms but tests negative for both the rheumatoid factor and anti-CCP antibodies. Diagnosis is based on symptoms alone in these cases.

How do ESR and CRP help in managing RA?

Both ESR and CRP are markers of inflammation. They are regularly checked to monitor how active RA is and to evaluate how well treatment is controlling the disease.

Why is early treatment important in RA?

Early treatment is crucial because RA is progressive and can cause joint damage, especially in the first two years. Starting treatment early helps slow the damage and prevent long-term joint erosion.

What imaging techniques are used to assess joint damage in RA?

X-rays, ultrasound, and sometimes MRI are used to check for joint damage. Ultrasound can detect even small amounts of inflammation that can't be felt and can help monitor soft tissue and tendon swelling.